Day Camp Registration

Special Registration Window -- Register between May 12 and May 22
to have your registration fee waived!

To Register for Day Camp

Before filling out the registration information below, download and read the Day Camp Parent Agreement. Then check the box 'I have read and agree to the terms of the Parent Agreement'.

To complete your registration, we must receive your registration fee. You can use the 'Pay Online' button found on this page to pay before or after submitting the registration form. If you prefer to pay by personal check, please send payments to 140 S. Front St, New Freedom, PA 17349. Include your child's/children's name(s) on your check. Registration is not complete until both the registration form and payment are received.

Complete the form below. After you hit the submit button (please only click it one time) you will receive a confirmation page.

Early Bird Discount – 5% off invoice if registered for 4 weeks and paid in full by first tuition due date

Multiple Children Discount -- $10 per week of 2nd or more children registered

NOTE: Multiple children can be registered. However, specific information is required for each child. Enter a childs name in the '#1 Camper's Name' field, hit enter, and the information required for the #1 Camper is displayed. To add a second camper enter a childs name in the '#2 Camper's Name' field, hit enter, and the information required for the #2 Camper is displayed. Repeat this process for a third or fourth Camper if required. After the individual camper content is complete, continue to complete the remaining required content.

#1 Camper's Name *

Pictures *

Please mark the 'weeks' and 'childcare' options you are registering for child #1.

** Registrations for the upcoming week must be made by end of Wednesday of the previous week. **

(i.e. Week 4 - Registration by end of Wednesday June 17th.)

(Week 1) Canceled

(Week 2) Canceled

(Week 3) June 15-19

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 4) June 22-26

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 5) June 29 - July 3

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 6) July 6-10

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 7) July 13-17

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 8) July 20-24

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 9) July 27-31

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 10) August 3-7

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 11) August 10-14

Full Week

Partial Week

AM Child Care

PM Child Care

#1 Birth Date *

#1 Grade Entering *

#1 Date of Last Tetanus Booster *

Month

Day

Year

#1 Allergies *

#1 Medical or Dietary Information *

#1 Behavioral, Learning or Physical Issues *

#2 Camper's Name

Pictures *

Please mark the 'weeks' and 'childcare' options you are registering for child #2.

** Registrations for the upcoming week must be made by end of Wednesday of the previous week. **

(i.e. Week 4 - Registration by end of Wednesday June 17th.)

(Week 1) Canceled

(Week 2) Canceled

(Week 3) June 15-19

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 4) June 22-26

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 5) June 29 - July 3

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 6) July 6-10

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 7) July 13-17

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 8) July 20-24

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 9) July 27-31

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 10) August 3-7

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 11) August 10-14

Full Week

Partial Week

AM Child Care

PM Child Care

#2 Birth Date *

#2 Grade Entering *

#2 Date of Last Tetanus Booster *

Month

Day

Year

#2 Allergies *

#2 Medical or Dietary Information *

#2 Behavioral, Learning or Physical Issues *

#3 Camper's Name

Pictures *

Please mark the 'weeks' and 'childcare' options you are registering for child #3.

** Registrations for the upcoming week must be made by end of Wednesday of the previous week. **

(i.e. Week 4 - Registration by end of Wednesday June 17th.)

(Week 1) Canceled

(Week 2) Canceled

(Week 3) June 15-19

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 4) June 22-26

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 5) June 29 - July 3

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 6) July 6-10

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 7) July 13-17

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 8) July 20-24

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 9) July 27-31

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 10) August 3-7

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 11) August 10-14

Full Week

Partial Week

AM Child Care

PM Child Care

#3 Birth Date *

#3 Grade Entering *

#3 Date of Last Tetanus Booster *

Month

Day

Year

#3 Allergies *

#3 Medical or Dietary Information *

#3 Behavioral Learning or Physical Issues *

#4 Camper's Name

Pictures *

Please mark the 'weeks' and 'childcare' options you are registering for child #4.

** Registrations for the upcoming week must be made by end of Wednesday of the previous week. **

(i.e. Week 4 - Registration by end of Wednesday June 17th.)

(Week 1) Canceled

(Week 2) Canceled

(Week 3) June 15-19

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 4) June 22-26

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 5) June 29 - July 3

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 6) July 6-10

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 7) July 13-17

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 8) July 20-24

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 9) July 27-31

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 10) August 3-7

Full Week

Partial Week

AM Child Care

PM Child Care

(Week 11) August 10-14

Full Week

Partial Week

AM Child Care

PM Child Care

#4 Birth Date *

#4 Grade Entering *

#4 Date of Last Tetanus Booster *

Month

Day

Year

#4 Allergies *

#4 Medical or Dietary Information *

#4 Behavioral Learning or Physical Issues *

Street Address *

City *

State *

Zip *

Phone Number *

Billing Contact Name *

Phone Number *

Email *

Day Camp Billing Disclaimer

Summit Grove will bill for all weeks marked. Any changes to this registration form must be approved by the office. After two changes, a $15 processing fee will be added for each additional change.

DAY CAMP EMERGENCY FORM 2020

Mother/Guardian Name *

Email *

Address 'Same as Camper' *

Yes

No

Street Address *

City *

State *

Zip *

Phone Number *

Alternate Phone Number *

Father/Guardian Name *

Email *

Address 'Same as Camper' *

Yes

No

Address *

City *

State

Zip *

Phone Number *

Alternate Phone Number *

Emergency Contact #1 *

Phone Number *

Emergency Contact #2 *

Phone Number *

Camper's Physician/Medical Care Provider *

Phone Number *

Address *

Insurance Provider *

Member/Policy Number *

ELECTRONIC SIGNATURE

If only one parent/guardian is provided for this form, that parent also certifies:
I hereby certify that this application has provided only one parent/guardian because (1) I am the sole parent/guardain responsible for this child or (2) I have made a good faith effort to obtain consent from the second parent/guardian but have not been able to do so due to reasons beyond my control.